The National Health Insurance Fund (NHIF) is regulated by the Health Insurance Act (1998), which introduced the mandatory health insurance and regulates the supplementary health insurance in Bulgaria. It was founded on 15th March 1999 as an independent public institution separated from the structure of the social healthcare system and has its own bodies of management. The NHIF budget is separated from the state budget. The National Assembly on an annual basis votes it. The NHIF Budget Act determines the amount of the health insurance contribution.
The obligatory health insurance is a system for health protection of the population. The NHIF carries out the obligatory health insurance in the country.
The voluntary health insurance is supplementary and is implemented by joint stock companies registered under the Commercial Law and licensed under the terms and procedure of the Health Insurance Act (HIA).
The obligatory health insurance in Bulgaria is implemented on the basis of the following MAJOR PRINCIPLES:
Obligatory participation in raising the contributions
This is the most typical principle of the present-day social security systems, which ensures that revenues have been generated from the contributions of all the citizens in the country.
Participation of the state, the insured and the employers in the NHIF management
The national health insurance fund is a public organisation and its structure follows the logic of funds being managed by those who pay in them. The “Employers, state and insured” tripartism is in the basis of the assembly of NHIF representatives and in governing the processes running in the national health insurance fund.
Solidarity of the insured in using the raised funds
The principle of solidarity provides for the possibility to redistribute the income from contributions from the healthy to the ill, from the rich to the poor, from the young to the adults.
Responsibility of the insured for their own health
Every insured individual has to be individually responsible for his/her health and fulfil the instructions of medical care providers and the requirements for disease prevention in accordance with the National Framework Contract (NFC) and the contracts with providers.
To be able to raise the responsibility for their own health, the insured citizens pay a certain user fee when using medical services. The user fee amount is fixed in the Health Insurance Act. This is a minimum cost, which does not depend on the real value of the services used. The amount paid per visit to a GP, a specialist from the outpatient medical care or a dentist is 1% of the minimum salary fixed for the country. 2% of the minimum salary for the country is paid for a day’s stay in a hospital care establishment, but not more than 10 days a year. A patient who needs a long treatment does not pay a user fee after the 10th day.
Certain groups of citizens have been exempted from the user fee: individuals suffering from diseases specified in a list in the National Framework Contract, expectant mothers, children under 18, unemployed, the military, war veterans, disabled soldiers, socially underprivileged and individuals in social institutions, medical specialists.
Equality in the use of medical care
Accessibility to medical care is a major requirement of the European social health insurance systems. All citizens have equal rights of access to medical care within the frames of the package of medical services guaranteed by the NHIF.
Equality of the medical care providers on signing contracts with a regional health insurance fund.
Every medical care provider registered with a given regional health insurance fund (RHIF) has the right to apply for a contract with a RHIF. The RHIF director may withhold conclusion of a contract with a provider meeting the requirements of the law and the NFC, including also cases when the health card has been filled in.
Self-government of NHIF
The NHIF was founded as an independent public institution separated from the structure of the public health protection system and has its own bodies of management.
Representatives of the insured individuals who stand up for their rights participate in the NHIF management, too.
Negotiating the relations between the NHIF and the medical care providers
According to the Health Insurance Act, the financial relations between NHIF and the medical care providers are negotiated at two levels:
national – by signing a National Framework Contract with the professional organisations of physicians and dentists;
Individual – by signing individual contracts.
If a provider of medical or dental care does not want to sign a contract with the health insurance fund, his/her work will not be paid for by the fund. The NHIF may withhold contracts of medical and dental care providers, if they do not meet the requirements for signing a contract and providing treatment of good quality.
The insured individuals are free to choose medical care providers who have signed a contract with the health insurance fund
With the introduction of the health insurance system, the freedom of choice of a medical care provider is guaranteed and the insured citizens have the right to use the services of medical professionals and of health and medical establishments that have concluded a contract with the health insurance fund, regardless of their location within the territory of the country and the form of ownership.
Publicity in the NHIF activities
The NHIF is a public organisation, which publishes its budget and reports, the rules of its operation and the National Framework Contract.
The HIA provides for wide possibilities for public, as well as financial control over the NHIF activities, carried out by the Ministry of Health, the Parliament, the Audit Office, the State Financial Control, the Directorate for Specialised Medical Supervision at the Ministry of Health, as well by the health insurance fund bodies of management – the Assembly of Representatives, the Board of Managers and the Audit Council.
The National Health Insurance Fund cannot possess health and medical establishments and pharmacies.